MassHealth Coverage Types and Member Forms

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MassHealth Mail and Fax Cover Sheet

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MassHealth has published a Mail and Fax Cover Sheet that should be used when sending documents to the Enrollment Centers or Central Processing Unit.  There are two important points to remember when using this form:

1. DO NOT PHOTOCOPY THIS FORM.  A new form should be printed with every use.  This form contains a barcode that is used by MassHealth's new scanning system.  Photocopying the form can diminish the integrity of the barcode and make it illegible to the scanning system.
2. Please use one cover sheet per household.  If you are sending documents for multiple cases, use a separate cover sheet for each case.